Dimensions of health

Dimensions of Health

Situation

Local community

City hospital

Social and emotional wellbeing

The Aboriginal elder residing in the rural community.

Challenges in understanding the interpreter. Uncomplicated recovery.

Family and community commitments

Has a partner and children who assisted in the recovery process. His brother died a year ago.

The patient stayed with the partner during the hospitalisation.

Personal, spiritual and cultural considerations

English is a third language.

An interpreter was imperative for interaction between the patient and the physician.

Physical and biological

No physical issues with the individual.

Patient required support for recovery after the surgery.

Perspective

Patient history

Diagnosis/referral

In hospital

Discharge/transfer

Follow-up

Patient’s journey

No history of the condition. Patient began by experiencing shortness of breath.

Myocardial infarction (heart attack).

Urgent treatment occurred in both Bairnsdale and Melbourne. Patient stayed for a week in the two hospitals.

Patient was discharged after three days of post-surgery. He was transferred from the local clinic after the urgent diagnosis. After recovery, the patient was discharged to his community.

Local health service was important for follow-up.

Family/carer journey

Patient has nuclear and extended family

Brother was diagnosed with cardiac complications.

Patient’s partner stayed with him throughout the hospital stay.

Patient had his partner throughout the discharge and transfers.

Patient’s partner and children were with him for support throughout the recovery.

Patient priorities, concerns and commitments:

Patient’s priority is health.

Family concerned with the patient’s diagnosis after the brother’s death.

Both partner and patient were concerned with the individual’s recovery.

Return to the community for the recovery.

Ensure full recover.

Health care/service priorities

Establish the individual’s history and that of the family members.

Establish the management approach.

Patient’s recovery.

Recover while in the community and in collaboration with the Aboriginal staff.

Follow-up by the local health services.

Language and

Table 2: Patient Journey

Importance of the Information in Table 2 Above and Consequences of not Enquiring or Recording

The patient’s journey from the local to urban medical facilities is characterised by various levels of interactions that demonstrate the challenges that these individuals face when seeking healthcare services. At the local facility, the patient’s interaction is easier compared to the healthcare facility in Melbourne. This difference is centred on factors such as the presence or lack of Aboriginal health care workers and language barriers. Another key disparity is the cultural competence of the healthcare providers at the Melbourne hospital. Besides the lack of an interpreter, some of the staff spoke quickly, and the doctor’s accent was challenging.

The importance of the information in table 2 is to understand the patient’s challenges and ensure a synchronised care. For quality and safe Aboriginal healthcare, the local facility should collaborate with that at the urban facility to ensure continuum in care delivery. According to Pearson et al. (2016), Australian healthcare providers are diversified and highly skilled, which is vital for them to provide quality and safe care to individuals regardless of whether they are Aboriginal or non-Aboriginal. This is not the case in the patient’s encounter, which demonstrates the disparities in healthcare services. Recording the information in table 2, including the cultural safety of the individual, is also essential in understanding the challenges faced by the patient in accessing care at both the local and Melbourne facilities.

Failure to record the information results in deficiency in knowledge on how the disparity in healthcare delivery can be addressed, especially among the Aboriginal population and the other Australians. According to Li (2017), fairness in delivery care should be reflected regardless of the individual’s geographic position, demographic, social, and economic factors. Healthcare providers should also establish the diverse factors that revolve around the individual. Failure to evaluate these elements, such as communication, impair the quality and person-centeredness in the care. For instance, failure to understand the language disparities that face the individual may confuse engaging with the individual, which is associated with poor quality and safety in the care.

Key Findings, Gaps, and Mitigation Strategies

From the case analysis, it is apparent that the Aboriginal elder man faced several challenges in accessing care. Also, it is evident that the cardiac conditions are in the individual’s family. This is reflected in the brother’s death a year ago, which was attributed to cardiac complications. According to Knowles and Ashley (2018), the epidemiological information regarding cardiovascular conditions reveals that a genetic basis is among the risk scores for the conditions revealed in this case. Another important finding is the challenges that the patient faces in accessing care. First, the local community healthcare facility establishes that he has a heart attack and is referred to as Bairnsdale and latter Melbourne. The main challenge was accessing the advanced healthcare facility and communicating with the healthcare providers since English was the third language. Other key elements in the findings were limited awareness and lack of adequate facilities in the community.

Cultural competence is a significant gap in healthcare access and delivery. As espoused by Kurtz et al. (2018), there are healthcare inequalities in Australia, the US, Canada, and New Zealand. Cultural competence and cultural safety entail generation, gender, occupation, and religious beliefs. Notably, the patient faces several challenges in accessing quality care since there was no available interpreter and understanding of the doctor’s accent. Another disparity is the level of resources in the community healthcare facility. Notably, the patient had to be referred to. There were, however, several delays, including lack of room on the retrieval plan. Notably, local healthcare facilities should be equipped with appropriate resources to provide sufficient services, including the surgery. The transportation was also essential to ensure the individual did not develop more complications before reaching the referred care. Another gap was the unavailability of the social worker until Monday, which implied more delays.

To address the gaps mentioned above, three strategies are essential. The first approach is conducting comprehensive education to the healthcare providers regarding cultural competence. Lin, Lee, and Huang (2017) posit that cultural competence is vital in appreciating and acknowledging the values and needs of the clients. Adequate education ensures healthcare providers can deliver quality care regardless of the individual’s affiliation. Another gap entails inadequate healthcare providers and social workers. This is demonstrated by the present workers being busy to listen and attend to the Aboriginal patient. This may be addressed by adequate staffing of the different healthcare providers to ensure quality and safety in patient care delivery. To address the gaps in facilities for local and urban healthcare facilities, adequate policies, should be established. These include increasing the allocation of resources to the local facilities. This would ensure that the facilities provide sufficient services to the patient.

Strategy Evaluation: Adequate and Cultural Competent Staffing

The main challenge in the patient’s journey, as demonstrated in table 2, entails inadequate services, which are also influenced by delays in accessing the services, including the interpreter and absence of a social worker. To address these challenges collectively, adequate staffing of healthcare providers is vital. However, the individuals hired should be diverse, with regards to their experience and competence. Besides the standard medical knowledge, they should also demonstrate cultural competence, which will ensure that they can assist patients across various diversities, including the aboriginal. As the healthcare facility plans to recruit more healthcare providers and social workers, it should acknowledge the importance of diversity in the area of practice. Notably, there should be an interpreter to avoid delays. This demonstrates the importance of hiring Aboriginal healthcare staff. A social worker is essential in working with the patient for other services, including addressing arrangement of financial services.

To implement this strategy of adequate staffing, who should be diverse in knowledge and practice, Kurt Lewin’s change approach is essential. The model entails unfreezing, change, and refreezing (Saleem, Sehar, Afzal, Jamil, & Gilani, 2019). The unfreezing stage involves demonstrating to the healthcare facility that change is required to ensure all patients, including the Aboriginal, have access to quality health. The hospital should understand the importance of more healthcare services providers, including social workers and individuals that can interpret to mitigate the delays. The change involves the hiring process of various healthcare providers. During the hiring process, all the areas in the hospital that have staffing needs should be included in the process. The refreezing stage entails ensuring that the healthcare providers are aligned to the organisational culture. In addition, the patient to healthcare providers’ ratio should be maintained. Cultural safety should become a norm among the healthcare providers, including the nurses and physicians. A culturally safe environment should be ensured, which is physically, emotionally, spiritually, and socially safe to the patients. The facility’s management conducts the implementation of the staffing strategy.

The efficiency of healthcare services is reflected in the reduced length of stay at the hospital, patient satisfaction, and the quality of stay at the medical facility. According to Du (2018), quality and safety are among the central approaches to promoting healthcare service delivery. Also, both the healthcare service providers and patients should be satisfied with the efficiency of these services. In this hospital, cultural competence among the healthcare providers is evaluated based on observations and the patients’ complaints and grievances. Nurses’ burnout and their feedback on adequate care should also be factored in measuring the efficiency of healthcare services delivery.

Reflection

The case study activity provided a learning opportunity for various elements. Among the key learning areas were cultural competence, patient evaluation at the local and urban facilities, and the importance of an interpreter. One of the issues that challenged me personally was filling tables 1 and 2. Notably, the tables required filling out various details and dimensions of health, including the social and emotional well-being, spiritual, personal, and cultural elements, as well as physical and biological issues. This information was challenging to establish from the presented case study. Some of the details appeared not available from the case study. A critical aspect that I could change in the future is marking out the patient’s journey and filling out the details in the tables. As I read the case study, it would be essential to establish the details and fill them as I progress. This would ensure I do not miss any details or confuse the elements.

One of the critical areas that I have learned entails cultural competence among healthcare providers. According to Harkess and Kaddoura (2016), the concept of cultural competence has become central in nursing practice and education. Various models are related to cultural competence, including person-centered care, which involves providing care, while acknowledging the individual’s factors, including culture. It is, therefore, imperative to include cultural competence development in my professional development plan. Another core element that I learned regarding Aboriginal and elderly care is the role of interpersonal, communication, and engagement skills among healthcare providers. These skills are vital in establishing a therapeutic relationship with the patient and developing the care management plan. In my professional development plan, these skills are essential. These skills would be necessary in my nursing practice.  

            Delivering healthcare services to the Aboriginals involves understanding their cultures and ensuring quality and safety outcomes in the management plan. The cardiac scenario case study demonstrates the challenges that Aboriginals face in accessing quality care services. The individual was diagnosed with a heart attack, which required his transfer to Bairnsdale and later Melbourne. Besides the challenges in accessing quality care in the urban area, the patient and his partner had setbacks in understanding the doctor due to accent differences. Also, there was inadequate staff, including an interpreter and social workers. To address these gaps, among the core strategies is adequate staffing. This would involve hiring more healthcare providers and social workers. Notably, healthcare providers should demonstrate cultural competence, which is vital in engaging Aboriginals. Other essential elements in working with Aboriginals, include interpersonal, communication, and engagement skills.

communication

Local interaction easy due to language similarity.

Diagnosis at the local hospital easy compared to that at the referral hospital.

The need for a telephone interpreter since English was the third language.

Discharge to the local services for recovery. Stayed at the local facility for two days.

Aboriginal healthcare worker responsible for recover.